integrated nor coordinated, and quality is unknown because
there is no system to measure its value or outcome.
challenges Remain Although its health care spending per capita has increased only modestly (in real terms, by 2. 2 percent between 2000 and 2006), Japan faces many challenges. Spending growth as a percent of GDP continues to increase because of a stagnant economy. And
the proportion of elderly in the population is growing rapidly
because of a low birth rate, the declining number of women of
childbearing age, and high life expectancy. The combination of
a rapidly aging population and relatively generous long-term
care benefits adds pressure to spending growth.
At the same time, financial stringencies have led to an under-investment in health care. For example, there is a shortage of
specialists in certain areas (obstetricians, pediatricians, and
geriatricians), the number of physicians remaining at large hospitals over the course of their careers continues to decrease,
patients in ambulances are turned away sometimes because of
inadequate hospital services, and there are insufficient hospitals and physicians in the rural areas. Finally, care is neither
April s. cHoi, principal and consulting actuary with kac
group llc, is a fellow of the society of actuaries, a member of
the academy and chairperson of its health Practice international
task force, and a member of the executive committee of the
international actuarial association’s health section.
References
Arnquist, Sarah, “Health Care Abroad: Japan,” New York Times, Aug. 25, 2009.
Ikegami, Naoki, and John C. Campbell, “Health Care Reform in Japan:
The Virtues of Muddling Through,” Health Affairs, 18.3: 56-75.
“International Health Systems— Japan,” Kaiseredu.org, www.kaiseredu.
org/ topics_im_ihs.asp?imID= 5&parentID= 61.
“Japan’s Health Care as a Model,” The Japan Times, Sept. 20, 2009.
Ministry of Health, Labor and Welfare, Japan, “Annual Health, Labour and
Welfare Report 2007-2008,”
www.mhlw.go.jp/english/wp/wp-hw2/part2/
p2c1s8.pdf,
www.mhlw.go.jp/english/wp/wp-hw2/part2/p3_0001.pdf.
“OECD Health Data 2009,” OECD,
www.oecd.org/japan.
Schabloski, Alyssa, “Health Care Systems Around the World,” Kaiser
Health News, Nov. 10, 2008,
www.kaiserhealthnews.org.
Tetsuo, Fukawa, “Public Health Insurance in Japan,” Working Paper of
the World Bank Institute,
http://unpan1.un.org/intradoc/groups/public/
documents/APCITY/UNPAN020063.pdf.
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